Letter: enhancing training opportunities for upper GI bleeding in Sheffield—a UK transferable model?

Adu-Tei, Sebastian; Raju, S.; Marks, Lauren; Daoub, Mohamed; Kakkar, Nishchay; Bevis, Edwin D. A.; Shiha, Mohamed G.; Ching, Hey-Long; Thoufeeq, Mo; Sanders, David S.

doi:10.1111/apt.16354

Cited by 6 publications

(1 citation statement)

References 4 publications

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“…Several training initiatives have been postulated in recent years, such as individual endoscopy lists and tailored training programmes, which aim to increase trainees' exposure to UGIB without risking patient safety. 24 However, although recommendations exist, these are not sufficiently implemented and applied in everyday clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Learning curve of achieving competency in emergency endoscopy in upper gastrointestinal bleeding: how much experience is necessary?

Allo,

Lang,

Martin

et al. 2024

BMJ Open Gastroenterol

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ObjectivesThe management of upper gastrointestinal bleeding (UGIB) has seen rapid advancements with revolutionising innovations. However, insufficient data exist on the necessary number of emergency endoscopies needed to achieve competency in haemostatic interventions.DesignWe retrospectively analysed all oesophagogastroduodenoscopies with signs of recent haemorrhage performed between 2015 and 2022 at our university hospital. A learning curve was created by plotting the number of previously performed oesophagogastroduodenoscopies with signs of recent haemorrhage against the treatment failure rate, defined as failed haemostasis, rebleeding and necessary surgical or radiological intervention.ResultsThe study population included 787 cases with a median age of 66 years. Active bleeding was detected in 576 cases (73.2%). Treatment failure occurred in 225 (28.6%) cases. The learning curve showed a marked decline in treatment failure rates after nine oesophagogastroduodenoscopies had been performed by the respective endoscopists followed by a first plateau between 20 and 50 procedures. A second decline was observed after 51 emergency procedures followed by a second plateau. Endoscopists with experience of <10 emergency procedures had higher treatment failure rates compared with endoscopists with >51 emergency oesophagogastroduodenoscopies performed (p=0.039) or consultants (p=0.041).ConclusionsOur data suggest that a minimum number of 20 oesophagogastroduodenoscopies with signs of recent haemorrhage is necessary before endoscopists should be considered proficient to perform emergency procedures independently. Endoscopists might be considered as advanced-qualified experts in managing UGIB after a minimum of 50 haemostatic procedure performed. Implementing recommendations on minimum numbers of emergency endoscopies in education programmes of endoscopy trainees could improve their confidence and competency in managing acute UGIB.

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Section: Discussionmentioning

confidence: 99%